Recommended Dosage for Bisacodyl
The recommended dose of bisacodyl is 10-15 mg daily, with a maximum of three times daily (tid), with the goal of achieving one non-forced bowel movement every 1-2 days. 1
Oral Administration
- Standard adult dose: 5-10 mg once daily, typically taken at bedtime
- Maximum dose: 10-15 mg up to three times daily for severe constipation
- Onset of action: 6-12 hours when taken orally
Rectal Administration
- Suppository dose: 10 mg per suppository 2
- Onset of action: 15-60 minutes when used rectally
- Administration: Insert rectally as directed
Dosing Considerations by Patient Population
Adults with Chronic Constipation
- Start with 5-10 mg oral dose once daily
- Clinical studies have shown that 10 mg daily is effective and well-tolerated for chronic constipation 3
- Increases mean number of complete spontaneous bowel movements from 1.1 to 5.2 per week 3
Elderly Patients
- Start at lower doses (5 mg) and titrate as needed
- Monitor more closely for dehydration and electrolyte disturbances 4
Pediatric Patients
- For refractory constipation in children, median effective dose is 5 mg/day 5
- Long-term use (median 14 months) has been shown to be effective and well-tolerated in pediatric patients with functional constipation not responding to conventional therapy 5
Use in Bowel Preparation for Colonoscopy
Bisacodyl can be used as part of bowel preparation regimens for colonoscopy:
- Split-dose regimen: 10-15 mg bisacodyl the evening before colonoscopy, followed by PEG solution 1
- Same-day regimen: 15 mg bisacodyl the day before, followed by PEG solution on the day of colonoscopy 1
- For afternoon colonoscopies, 3-4 tablets (15-20 mg) of bisacodyl at bedtime the night before, followed by 2L PEG-CS solution in the morning has been shown to be effective 6
Precautions and Contraindications
- Avoid use in patients with:
- Intestinal obstruction
- Acute abdominal conditions (appendicitis, acute inflammatory bowel disease)
- Severe dehydration
- Hypersensitivity to bisacodyl
Monitoring and Follow-up
- Assess bowel movement frequency and consistency
- Monitor for side effects such as abdominal cramping, diarrhea
- Long-term use should be monitored for electrolyte imbalances, particularly in elderly patients
Practical Tips
- Take oral bisacodyl on an empty stomach for best results
- Do not take within one hour of antacids or milk (can cause premature dissolution)
- Swallow tablets whole without crushing or chewing
- For chronic constipation, bisacodyl has been shown to improve not only bowel function but also quality of life 3
Remember that bisacodyl is a stimulant laxative and should be used as directed. While it can be used for longer periods in certain clinical situations, addressing underlying causes of constipation remains important.